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Abstract:
Background:
Pheochromocytoma is a rare
catecholamine-secreting tumour arising from chromaffin cells of the adrenal
medulla. It accounts for less than 0.2% of cases of hypertension, yet carries
significant morbidity due to cardiovascular complications and delayed
diagnosis. Classical manifestations include episodic headache, palpitations,
and sweating, although many patients present with atypical or nonspecific
symptoms.
Case Presentation:
We report the case of a 55-year-old
woman with a history of diabetes mellitus and hypertension who presented with
recurrent syncopal episodes, paroxysmal arrhythmias, and fluctuating blood
pressure. She was initially treated for presumed sepsis and myocarditis on
multiple admissions, with transient clinical improvement. Persistent labile
hypertension and catecholamine-related symptoms raised suspicion of a secondary
cause. Imaging studies revealed a left adrenal mass, and biochemical evaluation
confirmed markedly elevated urinary fractionated metanephrines and normetanephrines,
consistent with a catecholamine-secreting adrenal tumour. The patient was
optimized preoperatively with alpha- and beta-adrenergic blockade and underwent
successful laparoscopic adrenalectomy. Her postoperative recovery was
uneventful, with normalization of blood pressure and resolution of symptoms.
Discussion:
This case highlights the diagnostic
challenges of pheochromocytoma, which often masquerades as common
cardiovascular or psychiatric conditions.
Life-threatening side
effects like arrhythmias, myocarditis, and stress cardiomyopathy can be brought
on by catecholamine spikes. For a diagnosis, prompt imaging, biochemical
confirmation, and a high index of suspicion are essential. In order to reduce
perioperative risk, surgical resection must be performed first, followed by
sufficient adrenergic inhibition.
Conclusion
Patients with labile
hypertension, recurrent cardiac signs, and unexplained paroxysmal symptoms
should be evaluated for pheochromocytoma. In order to lower morbidity and
mortality, early detection and suitable treatment are essential.
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